historical information i
awes 01 Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
ueensbury, New York-12801
SE IC \DISPOSAL SYSTEM INSPECTION
NAME i
LOCATIO
DATE / (/ PERMITt`NO.
SOIL TYPE -(Sand.-1- Loam - Clay -
Percolation T� t Regg,.red? YES - NO
Percolation rate - Min/Inch _
N /'
TYPE of SYSTEMS:
Absorption field, total length f6-,
Length of each ,trerkh ?i/,,
Depth of trenchzes "0 ' "
Size of gravel / p.
SEEPAGE PITS4NuiibeCr of)
Size- ft. X 4= j ft.
Gravel size l j
PIPING: k, Size Type
Bldg. to tank A 4/ .,t'jj
Tank to dist. bo* 4< G/ /f
Dist. box to f ietld4/pit .!
Openings sealed / cE�S)s. NO Partial
} L�',�
LOCATION/SEPARA,TION : ' k ��'r -_�
Foundation totank 's. • ft. L� � re`�®�-�-EE '
Foundation to 4bsor tion (,2;; ft.
NOV 23 20�Absorption to of li�ie ,� ft. ® " 1,,,, 1
P��
Separation of Fits ft. "�"""=TF rT _ P
LOCATION OF S STEM ONE.PROPERTY(circle one) E111 J!L1:7 C.: r`
Front - Rear 4� Left side - Right side �u-_ .% � `:,
COMMENTS: 1 x
P r .
/ yy ,f/�f f 1 //—f
f 4
1
t
[ ‘,
r; y
€,
SYSTEM USE I°PPROVEDf YE / I Oq
J
, x / fil
Bihldl g`‘3x sp ctor
01/86 and vl
APPLICATION FOR
SEPTIC DISPOSAL PERMIT
fafj
1)11
" 1
29020 IDATE '-- ii� Hov23
TOWN OF r'a LIE,r S;,
BUILPin,, e:COD j
LOCATION OF PROPERTY FOR INSTALLATION ;t r 2. ( r 5K,!`e=1--- --
Owner's Name: PALL-- �� 4'j��� - Telephoner;' )'-' 2)/( r
Address: -P. 4- + ►�' a ' r%„ i�
Installer's Name: /U C' / ;iG c. i% 4CJ,I'Y ) Telephone: (.%4�;) '' 4J
Number of bedrooms (residential only)
Total daily flow (compute O. 150 gal per bedroom)
Topography: Circle one:LFlatt Rolling Steep Slope % of Slope
Soil Nature: Circle one4Sandi Loam Clay Other /Depth: Feet
Ground Water: At what depth? to Feet
Bedrock or Impervious Material: At what depth? / Feet •
Percolation test: Circle one: not requit dJ required rate min. inch.
Domestic water supply: circle one: Municipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption i J 11.i1N/M IGf2-7 feet
PROPOSED SYSTEM: Septic Tank /, e7C% gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench G feet/Total system length = " )ice feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # 2 /Depth or Thickness "T?�i� }C ``2_ LoicerW feet
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I have read the regulation on the reverse side of this sheet and agree to abide by these
and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: Aedf.
DATE: /a6/90
OVER